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Biomedical subjects

R J Luchi

Publications and source records attributed to R J Luchi.

At least 19 recordsLinked to original sources
PubMed1992

Survival of elderly men with congestive heart failure.

Congestive heart failure (CHF) is the most common discharge diagnosis for elderly patients. The survival of elderly (age greater than or equal to 75 years) patients with CHF has not recently been reported, especially with reference to left ventricular ejection fraction (LVEF). A patient database was searched for the diagnosis of CHF and then screened for age greater than or equal to 75, Framingham Criteria for CHF and an LVEF evaluation. Ninety-four men fitted all criteria, including a minimum potential follow-up of 3 years. Life-table analysis was employed to compare their survival experience to an expected survival based on a sex- and age-equivalent subset of the 1980 Census data. Causes of death were determined from autopsy, medical records or death certificates. Mean age at onset of CHF was 82.5. Forty-three per cent had an LVEF greater than or equal to 0.45. There was no difference in the prevalence of potential aetiologies between those with LVEF greater than or equal to 0.45 versus LVEF less than 0.45. Life-table analysis revealed that CHF patients had a worse survival than controls for the first 5 years after diagnosis, attributable primarily to a high first-year mortality (28%) for the CHF group. There was no difference in survival between the LVEF greater than or equal to 0.45 and LVEF less than 0.45 groups.

Aged↗
PubMed1992

Geriatrics fellows' perceptions of the quality of their research training.

In the last quarter of 1987-88, 95 second- and third-year geriatrics fellows were surveyed to examine their perceptions of the quality of research training available through their programs. A three-phase Delphi survey method was used, with the numbers of individuals responding per phase ranging from 58 (61%) to 68 (72%). The responses were clustered in five areas by means of factor analysis using a varimax rotation procedure. The fellows perceived their research training to be inadequate, primarily due to insufficient time for research activities and to inadequate exposure to research-qualified scientists. The authors conclude that although the fellows strongly supported the notion of a research-focused third fellowship year, implementing such a plan may be futile if new resources are not made available.

Delphi Technique↗
PubMed1991

Educating the elderly: cardiopulmonary resuscitation decisions before and after intervention.

Considering the limited success of cardiopulmonary resuscitation (CPR) in achieving survival to hospital discharge in older persons, it is appropriate to educate, discuss and determine patients' wishes at a time when they are able. Sixty-four ambulatory, non-depressed, non-demented veterans greater than 74 years of age were interviewed and educated. Knowledge of CPR at baseline was variable and most overestimated their survival chances. Most subjects desired routine CPR discussions with physicians. Only 17% had previously discussed their CPR preferences, and none had done so with physicians. Knowledge of CPR increased (P = 0.01) after educational intervention. There was no change in subjects' CPR decisions after education and presentation of current CPR outcome data. In considering five hypothetical scenarios, 9% never wanted CPR, and 17% always wanted CPR. Those who never wanted CPR were more realistic about their suspected survival chance (P = 0.003) and had higher educational levels (P = 0.03) Folstein (P = 0.03) and Geriatric Depression Scale (P = 0.04) scores. With the dependent variable being the number of hypothetical situations in which the patient desired CPR, a regression analysis (adjusted r2 = 0.72) limited significant variables to the patient's current CPR decision, Folstein score, religion, marital status, and previous ICU admissions. This study emphasizes that most elderly male veterans are willing and want to discuss their CPR attitude with physicians and that most have fixed CPR decisions which may be elicited under stable clinical conditions.

Aged↗
PubMed1991

Quality of life after bypass surgery for unstable angina. 5-year follow-up results of a Veterans Affairs Cooperative Study.

To assess the effect of bypass surgery on outcome from unstable angina, 468 patients were randomized to medical treatment (237 patients) or surgery plus medical treatment (231 patients) and have been followed for comparison of survival, cardiac end points, and quality of life; the latter end point is discussed in the present report. Data were available at 3 and 5 years for 80% and 82% of patients in the medical group, respectively, and 77% and 80% of patients in the surgery group, respectively. At 3 months after randomization to therapy, 79.8% of patients in the surgery group reported subjective improvement, compared with 58% of the medical group, 12.6% of the surgery group reported no change compared with 24.5% of the medical group, and 5.5% of the surgery group reported worsening compared with 24.5% of the medical group (p less than 0.01 by chi 2). Similar data were found for chest pain status, and the benefit to the surgery group remained statistically significant through 5 years of follow-up. Crossover rate to surgery was 43% by 5 years. Treadmill duration was increased in the surgery group compared with the medical group (6.5 +/- 0.25 versus 5.3 +/- 0.25 minutes at 6 months, p less than 0.01), and a significant difference was again demonstrated at 3 and 5 years. A trend toward decreased recurrence of unstable angina was present in the surgery group at 1 year (six of 168 [3.6%] versus 13 of 187 [6.9%] in the medical group, p = 0.158), but the two groups were similar at 3 and 5 years.(ABSTRACT TRUNCATED AT 250 WORDS)

Angina, Unstable↗
PubMed1991

Coronary bypass surgery improves survival in high-risk unstable angina. Results of a Veterans Administration Cooperative study with an 8-year follow-up. Veterans Administration Unstable Angina Cooperative Study Group.

To identify high-risk subgroups, 468 patients with unstable angina were prospectively stratified according to the clinical presentation of unstable angina (type I or type II) and left ventricular function (normal or abnormal) and were randomized to conventional medical therapy or surgical treatment with coronary bypass surgery. Type I patients (n = 374) were those who had progressive effort angina or recent angina at rest. Type II patients (n = 94) were those who had severe rest angina associated with ST-T changes on the electrocardiogram. Follow-up for 8 years showed that the cumulative mortality rates for type II patients with abnormal left ventricular function were significantly lower in the surgical patients compared with the medical cohorts (13% versus 46%, p less than 0.04). In the other subgroups, cumulative medical and surgical mortality rates were not different. Thus, type II patients with abnormal left ventricular function appear to be the subgroup of patients who are at the highest risk with medical therapy. Coronary bypass surgery significantly reduces the mortality in this high-risk subgroup of patients with unstable angina.

Angina, Unstable↗
PubMed1990

Estimation of survival time in terminal cancer patients: an impedance to hospice admissions?

Accurate estimation of survival time in terminal cancer patients is difficult yet may provide useful information. A historical prospective study on 172 patients admitted to a home based hospice service was performed to determine which variables were best correlated with survival time. Mean and median survival were 48 and 22 days, respectively, representing a highly skewed distribution of life span in this sample. As age increased, survival time decreased. All Activities of Daily Living (ADLs) recorded (Bathing, Continence, Dressing and Transfer) as well as other measures of performance (mobility and pulse) and nutrition (appetite and nourishment) were each strongly associated with survival. Multivariate analysis limited significant variables to dressing ability, pulse rate, level of appetite and transferring ability. Outliers (survival greater than 180 days) were differentiated from the remainder of the sample by significant differences in all ADLs recorded as well as the level of appetite. These findings establish the importance of assessing ADLs, a measure of functional status, and reinforce the importance of performance and nutrition measures when estimating length of survival in terminal cancer patients.

Activities of Daily Living↗
PubMed1989

Medical compared with surgical management of unstable angina. 5-year mortality and morbidity in the Veterans Administration Study.

We evaluated medical in comparison to surgical plus medical (surgical) treatment of unstable angina using a prospective randomized protocol that stratified patients by clinical presentation and by invasive evaluation of left ventricular (LV) function. Clinical presentations were as follows--type 1: progressive or new onset angina relieved by medication; type 2: prolonged bouts of angina poorly or incompletely relieved by medication. Abnormal LV function was arbitrarily defined as ejection fraction less than 0.50 or LV end-diastolic pressure 16 mm Hg or more. Of 468 patients, 237 were assigned to medical and 231 to surgical therapy. There were 374 type 1 and 94 type 2 patients. LV function was normal in 334 and abnormal in 134 patients. Compared with results at 24 months, this 60-month follow-up study showed important differences in survival for patients with three-vessel disease: 75% for medical and 89% for surgical patients (p less than 0.02). The cumulative 5-year rate of repeat hospitalizations for cardiac reasons was less with surgical patients for either clinical presentation. For type 1, medical patients had a 56% rate, and surgical patients had a 42% rate (p = 0.004). For type 2, medical patients had a 62% rate, and surgical patients had a 43% rate (p = 0.05). Overall mortality did not differ between the two treatments, and this remained true in type 1 versus type 2 patients and in those with normal versus abnormal LV function. However, regression analysis of medical and surgical groups with ejection fraction as a continuous variable showed that mortality of medical patients depended on ejection fraction (p = 0.004), whereas the mortality of surgical patients did not (p = 0.76), and survival in the surgical group was higher in the lowest ejection fraction tercile-73% for medical and 86% for surgical patients, p = 0.03. We conclude that surgery improves survival in patients with three-vessel disease and leads to fewer subsequent hospitalizations for cardiac reasons. An impaired ejection fraction had an adverse impact on survival of medical patients but not on surgical patients, and mortality in surgical patients was improved compared with medical patients in the lowest ejection fraction tercile.

Angina Pectoris↗
PubMed1988

In-hospital cardiopulmonary resuscitation.

A retrospective review of 399 cardiopulmonary resuscitation (CPR) efforts in 329 veterans was performed to evaluate the observation that few geriatric patients were discharged alive after they underwent CPR. Cardiopulmonary resuscitation efforts with witnessed arrests were more frequently successful than efforts with unwitnessed arrests (47.7% vs 29.9%) and resulted in live discharge more often than efforts with unwitnessed arrests. Cardiopulmonary resuscitation efforts that resulted in a live discharge were more brief and involved a lower mean number of medication doses. Of the 77 CPR efforts in patients 70 years of age or older who had arrests, 24 (31%) were successful, and in 22 (92%), patients were alive after 24 hours. None lived to discharge. There were 322 CPR efforts in the younger cohort; 137 (43%) were successful, in 124 (91%) of these 137 efforts, patients were alive after 24 hours, and in 22 (16%), patients were discharged alive. Older patients were significantly less likely to live to discharge both at the time of arrest and 24 hours after successful resuscitation. When a multivariate analysis was used, the presence of sepsis, cancer, increased age, increased number of medication doses administered, and absence of witness were all "predictive" of poor outcome. Cardiopulmonary resuscitation should be administered only to those who have the greatest potential benefit from this emotionally and physically traumatic procedure.

Adult↗
PubMed1988

Urinary incontinence in a community-residing elderly population.

A self-administered postal questionnaire was presented to all attending members (843) of local summer meetings of a national association for retired persons. A 71% response rate (599) revealed that 33% of the total sample population experienced some form of urinary incontinence. Twenty-three and seven-tenths percent (142) experienced occasional urine dribbling, 2.3% (14) were unable to prevent involuntary emptying of their bladder, and 7.3% (44) suffered both problems. Eighty-three percent of the respondents were between the ages of 65 and 85 years. Females accounted for 75% of all respondents. Respondents 75 years of age or older had a higher occurrence of all forms of urinary incontinence (P = 0.57), and a strong association existed with the same age-group and uncontrolled emptying of the bladder (P = .02). Thirty-seven percent of the females and 22% of the males reported having had an incontinent episode (P = .002). High parity (four or more births) was significantly associated with incontinence in females (P = .04). These survey findings provide prevalence estimates of urinary incontinence that are greater than those previously reported and show statistical differences by age and gender. The study population is not representative of all the noninstitutionalized elderly, but consists primarily of individuals who are active, ambulatory, generally healthy and may underestimate the magnitude of the problem. Urinary incontinence is substantiated as a major health problem in even the most functional community-residing elderly citizens.

Activities of Daily Living↗
PubMed1988

Veterans Administration Cooperative Study for treatment of patients with unstable angina. Results in patients with abnormal left ventricular function.

In a prospective randomized trial, 468 patients with unstable angina pectoris who were stratified according to clinical presentation (Type I or Type II angina) and left ventricular function (normal or abnormal) were assigned to medical or surgical treatment groups. Left ventricular function was defined as abnormal if the ejection fraction was less than 0.50, or if the end-diastolic pressure was 16 mm Hg or greater. Left ventricular function was abnormal in 134 patients, 66 of whom were assigned to surgical and 68 to medical treatment groups. The cumulative 3-year mortality for surgical patients was 6.1% and for medical patients, 17.6% (p = 0.039). This 3-year figure represents a 65% reduction in mortality with surgery. Survival was significantly better for surgical patients whose ejection fractions ranged from 0.30 to 0.49 (p = 0.05). Survival of patients whose ejection fractions were greater than 0.69 was better with medical treatment (p = 0.049). Thus, surgery appears to be the treatment of choice for patients with unstable angina pectoris and abnormal left ventricular function.

Aged↗
PubMed1987

Comparison of medical and surgical treatment for unstable angina pectoris. Results of a Veterans Administration Cooperative Study.

We conducted a multicenter, randomized, prospective study comparing medical therapy alone with coronary-artery bypass surgery plus medical therapy in 468 men with unstable angina pectoris. Patients were entered in the study from June 1, 1976, to June 30, 1982. Among those assigned to surgery who received bypass grafts, operative mortality was 4.1 percent. Arteriography performed after one year of follow-up revealed that 74.8 percent of the grafts studied were patent. The cumulative rate of crossover from medical to surgical therapy after two years was 34 percent; the operative mortality among patients crossed over was 10.3 percent. Nonfatal myocardial infarction occurred in 11.7 percent of the patients treated surgically and 12.2 percent of those treated medically (no significant difference). Most of the nonfatal myocardial infarctions in the surgical group occurred in the perioperative period. Overall, the two-year survival rate computed by life-table analysis did not differ between the two groups. However, the curves reflecting mortality as a function of left ventricular ejection fraction were significantly different (P = 0.03); surgery was associated with a significantly reduced mortality among patients with lower ejection fractions. We conclude that patients with unstable angina pectoris have a similar outcome after two years whether they receive medical therapy alone or coronary bypass surgery plus medical therapy. However, patients with reduced left ventricular ejection fractions may have a better two-year survival rate after coronary bypass surgery.

Adrenergic beta-Antagonists↗
PubMed1987

Cardiac tamponade and constrictive pericarditis complicating endoscopic sclerotherapy.

We report a case of suspected esophageal perforation with injection of a sclerosing agent into the pericardium during endoscopic sclerotherapy of esophageal varices. Immediately after the procedure, the patient developed fever and a pericardial friction rub. Eight months later, he presented with cardiac tamponade and constrictive pericarditis. This complication should be considered whenever a patient presents with inadequate cardiac output, venous congestion, and a pulsus paradoxus following sclerotherapy.

Adult↗
PubMed1985

Penile laceration from a Foley catheter.

Traction-induced penile laceration has not been reported previously as a complication of long-term indwelling Foley catheterization. Four occurrences of this injury in three elderly, demented patients were observed in an acute-care Geriatric Evaluation Unit. The most severe case, a nearly complete transverse laceration of the glans, reepithelialized but did not reapproximate. In the other cases, a laceration along the median raphe reapproximated. In all cases, local treatment was successful in effecting healing, and none of the patients exhibited signs or symptoms of systemic illness. These injuries were caused by prolonged traction on the unsecured Foley between the inflated balloon and the weighted collection system producing a local ischemic necrosis. This complication can be prevented by securing the Foley to the patient with tape, ensuring that the drainage system is properly supported, and by attention to patient position.

Aged↗